Legislature(2015 - 2016)CAPITOL 106

03/17/2016 03:00 PM HEALTH & SOCIAL SERVICES

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* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+= HB 234 INSURANCE COVERAGE FOR TELEMEDICINE TELECONFERENCED
Moved HB 234 Out of Committee
-- Public Testimony --
+= HB 237 INTERSTATE MEDICAL LICENSURE COMPACT TELECONFERENCED
Moved HB 237 Out of Committee
-- Public Testimony --
+ Bills Previously Heard/Scheduled TELECONFERENCED
+= HB 344 DRUG PRESCRIPTION DATABASE TELECONFERENCED
Scheduled but Not Heard
          HB 237-INTERSTATE MEDICAL LICENSURE COMPACT                                                                       
                                                                                                                                
4:35:48 PM                                                                                                                    
                                                                                                                                
CHAIR SEATON announced that the  final order of business would be                                                               
HOUSE BILL NO. 237, "An Act  relating to an interstate compact on                                                               
medical  licensure;  amending the  duties  of  the State  Medical                                                               
Board;  and  relating  to  the   Department  of  Public  Safety's                                                               
authority to  conduct national criminal history  record checks of                                                               
physicians."                                                                                                                    
                                                                                                                                
4:36:19 PM                                                                                                                    
                                                                                                                                
TANEEKA HANSEN,  Staff, Representative Paul Seaton,  Alaska State                                                               
Legislature,  stated that  this was  model legislation,  and that                                                               
there  were currently  12 states  in the  Compact, with  14 other                                                               
states,  including Alaska,  considering  this  legislation.   She                                                               
paraphrased from  the FAQ [included  in members'  packets], which                                                               
read:                                                                                                                           
                                                                                                                                
     The Interstate  Medical Licensure Compact  would create                                                                    
     a new  pathway to expedite the  licensing of physicians                                                                    
     seeking to  practice medicine  in multiple  states. The                                                                    
     proposal  could  increase  access to  health  care  for                                                                    
     individuals  in underserved  or rural  areas and  allow                                                                    
     patients  to   more  easily  consult   medical  experts                                                                    
     through  the  use  of  telemedicine  technologies.  The                                                                    
     Compact would  make it easier for  physicians to obtain                                                                    
     licenses  to  practice  in multiple  states  and  would                                                                    
     strengthen  public  protection  because it  would  help                                                                    
     states    share    investigative    and    disciplinary                                                                    
     information that they cannot share now.                                                                                    
                                                                                                                                
MS. HANSEN reviewed the proposed  bill, and stated that the first                                                               
six  Sections were  conforming language  and applied  to existing                                                               
state statute of the medical  board.  These sections directed the                                                               
board  to  implement the  Compact.    She directed  attention  to                                                               
Section 2, which added to  the board requirement that a physician                                                               
shall submit their fingerprints  along with their application and                                                               
fees for  an expedited  license and  a national  criminal history                                                               
record  check.    She  noted  that  the  medical  board  did  not                                                               
currently  do  background checks  for  applicants,  and were  not                                                               
currently  authorized  to  do  so.     She  pointed  out  that  a                                                               
background check was required for this expedited license.                                                                       
                                                                                                                                
CHAIR  SEATON clarified  that an  expedited  license through  the                                                               
Compact would have a more  thorough background check than someone                                                               
solely applying for a license in Alaska.                                                                                        
                                                                                                                                
MS.  HANSEN expressed  agreement, specifically  for the  criminal                                                               
background check connected with  fingerprints.  She surmised that                                                               
unless a  background check was  specifically noticed  in statute,                                                               
it was not allowed.                                                                                                             
                                                                                                                                
4:39:49 PM                                                                                                                    
                                                                                                                                
MS.  HANSEN  moved  on  to  page 5  of  the  proposed  bill,  and                                                               
addressed  the  definition  for an  eligible  physician  to  this                                                               
expedited license,  which included graduation from  an accredited                                                               
medical   school,  passing   each   component   of  a   licensing                                                               
examination, successfully completing  graduate medical education,                                                               
a  specialty certification  from  the American  Board of  Medical                                                               
Specialists, and  a full  and unrestricted  license to  engage in                                                               
the  practice of  medicine.    They would  also  never have  been                                                               
convicted of an  offense by a court  of appropriate jurisdiction,                                                               
never held  a license subject  to discipline, and were  not under                                                               
active investigation.                                                                                                           
                                                                                                                                
MS. HANSEN stated that there  were similar licensing requirements                                                               
by the State of Alaska,  which included graduation from a medical                                                               
school and no encumbrance on your  license.  She relayed that the                                                               
requirements under  the Compact  were more specific,  noting that                                                               
Alaska  did  not  require  the   specialty  certification.    She                                                               
reported  that the  idea  behind  the Compact  was  to allow  any                                                               
physician  who  qualified to  pay  the  necessary fees  and  have                                                               
license in another Compact state.   They would be responsible for                                                               
all  medical  and  malpractice  laws  in  each  state  they  were                                                               
licensed.    She   shared  that  there  were   concerns  for  the                                                               
relinquishing  of  state authority  to  the  federation of  state                                                               
medical boards; however, she pointed  out that each of the voting                                                               
members  of the  Commission  were members  of  the state  medical                                                               
board from the member states.                                                                                                   
                                                                                                                                
4:44:19 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  TARR referenced  the  aforementioned letter  from                                                               
Ms.  Maureen  Powers,  dated  February  11,  2016,  [included  in                                                               
members' packets], which  read:  "There is no  discretion to look                                                               
at    moral    character,     malpractice    history,    training                                                               
irregularities,  or other  requirements."   She asked  what would                                                               
happen in  a circumstance related to  any of those issues  if one                                                               
of  the  Compact  states  had a  more  restrictive  statute  than                                                               
another;  which would  take precedence,  the more  restrictive or                                                               
the least restrictive.                                                                                                          
                                                                                                                                
MS. HANSEN  explained that the  qualifications for  the expedited                                                               
licenses were  presented in the  Compact.  She stated  that these                                                               
were  stricter  than the  Alaska  statutes,  as the  Compact  was                                                               
drafted   to  be   the  strictest   version   of  the   licensure                                                               
requirements;  hence the  reason for  inclusion of  the specialty                                                               
certification.  She relayed that  an intention of the Compact was                                                               
to hold those physicians applying  for the expedited licensure to                                                               
the highest  level of requirements.   She noted that  a physician                                                               
could  apply  using a  normal  procedure  through the  individual                                                               
state medical  boards if they  did not qualify for  the expedited                                                               
license.                                                                                                                        
                                                                                                                                
REPRESENTATIVE TARR  asked about the cost  of the recertification                                                               
process mentioned  in the aforementioned  letter, and  whether it                                                               
was   possible   to   "sync   up"   during   the   next   natural                                                               
recertification.                                                                                                                
                                                                                                                                
MS.  HANSEN replied  that the  Compact had  no effect  on current                                                               
licensees unless  they desired  to get  an expedited  license for                                                               
automatic licensing in other Compact states.                                                                                    
                                                                                                                                
REPRESENTATIVE TARR mused that the  physician could then continue                                                               
their scope of practice and  not engage in activities outside the                                                               
state.                                                                                                                          
                                                                                                                                
4:47:40 PM                                                                                                                    
                                                                                                                                
CHAIR SEATON  reminded the committee  that the proposed  bill was                                                               
being considered because it took so  long for many doctors to get                                                               
licensed in  Alaska, and  that this  was an  attempt to  make the                                                               
system work better to more  easily get physicians into the state.                                                               
He  stated that,  as  the  state did  not  want  to lose  doctors                                                               
because of delays in the  state's system, a doctor already having                                                               
a license in a Compact state  could more easily get the expedited                                                               
license.  He emphasized that all the fees still had to be paid.                                                                 
                                                                                                                                
REPRESENTATIVE WOOL asked  if this would affect  a newly licensed                                                               
medical professional coming  to Alaska to practice  for the first                                                               
time.                                                                                                                           
                                                                                                                                
MS.  HANSEN  replied  that,  as  a  requirement  to  receive  the                                                               
expedited license  was to already  possess a license,  they would                                                               
have to go through the examination process.                                                                                     
                                                                                                                                
CHAIR SEATON pointed  out that someone with  a specialty license,                                                               
as well  as licenses in other  states, who was still  waiting for                                                               
an Alaska license  under the current system,  could apply through                                                               
the Compact  if they met  all the  other criteria.   He clarified                                                               
that   a  specialty   license   included   family  practice   and                                                               
preventative medicine, and was not limited to brain surgery.                                                                    
                                                                                                                                
MS. HANSEN  explained that any disciplinary  action or suspension                                                               
in one  state would result  in notification to the  other Compact                                                               
states, each of  which would then decide whether  to maintain the                                                               
action or reinstate the license.                                                                                                
                                                                                                                                
REPRESENTATIVE  WOOL asked  if a  practitioner  in another  state                                                               
could come to Alaska and apply  for a license through the current                                                               
system,  opting to  not apply  through the  Compact because  of a                                                               
prior disciplinary action in a Compact state.                                                                                   
                                                                                                                                
MS.  HANSEN replied  that the  Alaska State  Medical Board  would                                                               
also   review  disciplinary   actions,   but   allowed  for   the                                                               
possibility of more leniency should  the board decide that action                                                               
was not  a concern.   She  opined that  for a  physician applying                                                               
under  the language  of  the Compact,  the  Alaska State  Medical                                                               
Board would not have this discretion.                                                                                           
                                                                                                                                
4:52:54 PM                                                                                                                    
                                                                                                                                
CHAIR SEATON opened public testimony.                                                                                           
                                                                                                                                
4:54:03 PM                                                                                                                    
                                                                                                                                
JAY  BUTLER, MD,  Chief Medical  Officer/  DPH Director,  Central                                                               
Office,  Division  of Public  Health,  Department  of Health  and                                                               
Social Services, listed some of  the advantages for participation                                                               
in the  Compact which included  increased ease in  recruiting and                                                               
faster "on-boarding"  of providers  when they arrived  in Alaska.                                                               
This allowed  for providers and sub-specialty  providers to begin                                                               
service more  quickly in  underserved areas  and facilities.   He                                                               
reported  that  this  also   streamlined  the  participation  and                                                               
availability by out  of state providers in  limited emergency and                                                               
disaster  responses, those  events that  were not  big enough  to                                                               
lead  to a  state disaster  declaration  and the  use of  federal                                                               
assets, such as a localized infectious disease outbreak.                                                                        
                                                                                                                                
REPRESENTATIVE WOOL  asked if this  would allow the  inclusion of                                                               
providers from another Compact state  through telemedicine.  This                                                               
would  allow medical  personnel to  have multiple  licenses while                                                               
residing in only one state.                                                                                                     
                                                                                                                                
DR. BUTLER replied  that it would be included  if the requirement                                                               
for   provision  of   telemedicine   services  included   medical                                                               
licensing in Alaska.                                                                                                            
                                                                                                                                
CHAIR  SEATON shared  that these  requirements included  those in                                                               
the  upper levels  of  the profession  to  receive the  expedited                                                               
license.                                                                                                                        
                                                                                                                                
4:57:33 PM                                                                                                                    
                                                                                                                                
KEVIN LUPPEN, Alaska  State Medical Board, stated  the support of                                                               
the Alaska  State Medical  Board for the  proposed bill,  HB 237.                                                               
He  offered a  personal anecdote  for the  loss of  practitioners                                                               
because of the current delays in licensing.                                                                                     
                                                                                                                                
REPRESENTATIVE TARR asked if the  Alaska State Medical Board were                                                               
related to the Federation of State Medical Boards.                                                                              
                                                                                                                                
MR. LUPPEN replied no.                                                                                                          
                                                                                                                                
REPRESENTATIVE TARR  asked if  there was  any mistrust  with this                                                               
national organization.                                                                                                          
                                                                                                                                
MR. LUPPEN replied  that there had not been any  concern from the                                                               
state board with the national  organization, and that some trends                                                               
and expertise  had been provided to  the state board.   He stated                                                               
that  he had  not seen  any potential  threats from  the national                                                               
organization.                                                                                                                   
                                                                                                                                
5:00:11 PM                                                                                                                    
                                                                                                                                
CHAIR  SEATON  directed attention  to  page  7,  line 8,  of  the                                                               
proposed bill which stated the  requirement that a formal license                                                               
application had  to be submitted,  contrary to the claims  of the                                                               
aforementioned letter to the committee.                                                                                         
                                                                                                                                
5:01:32 PM                                                                                                                    
                                                                                                                                
CHAIR SEATON  closed public testimony  after ascertaining  no one                                                               
further wished to testify.                                                                                                      
                                                                                                                                
5:01:43 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE VAZQUEZ directed  attention to page 4,  line 2, of                                                               
the proposed bill,  and she highlighted that the  Compact did not                                                               
change the existing medical practice act  of the state.  She read                                                               
from page 4, line 7, of the proposed bill:                                                                                      
                                                                                                                                
     State medical  boards that  participate in  the Compact                                                                    
     retain  the jurisdiction  to impose  an adverse  action                                                                    
     against a  license to practice  medicine in  that state                                                                    
     issued  to a  physician through  the procedures  in the                                                                    
     Compact.                                                                                                                   
                                                                                                                                
REPRESENTATIVE VAZQUEZ  pointed to  page 6,  lines 22-25,  of the                                                               
proposed bill,  which clarified  that the  proposed bill  did not                                                               
usurp the current Alaska law.                                                                                                   
                                                                                                                                
5:03:31 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  VAZQUEZ  moved  to  report HB  237,  labeled  29-                                                               
LS1100\A, out  of committee  with individual  recommendations and                                                               
the  accompanying indeterminate  fiscal  notes.   There being  no                                                               
objection,  HB 237  was moved  from the  House Health  and Social                                                               
Services Standing Committee.                                                                                                    

Document Name Date/Time Subjects
HB 237 Support_American Osteopathic_ 3 15 16.pdf HHSS 3/17/2016 3:00:00 PM
HB 237
HB234 Lynn Edwards email.pdf HHSS 3/17/2016 3:00:00 PM
HB 234
HB234 Lita White email.pdf HHSS 3/17/2016 3:00:00 PM
HB 234
HB234 Maureen Lawlor email.pdf HHSS 3/17/2016 3:00:00 PM
HB 234
HB234 Pamela Lund.pdf HHSS 3/17/2016 3:00:00 PM
HB 234
HB234 Sheila Gallagher.pdf HHSS 3/17/2016 3:00:00 PM
HB 234
HB234 Joel Wieman - Licensing board member.pdf HHSS 3/17/2016 3:00:00 PM
HB 234
HB234 Bryan Thomas email.pdf HHSS 3/17/2016 3:00:00 PM
HB 234
HB 234 Support _Lise Kirsis 3.14.2016.pdf HHSS 3/17/2016 3:00:00 PM
HB 234
HB234 Bobbie email.pdf HHSS 3/17/2016 3:00:00 PM
HB 234
HB234 Support Alaska Mental Health Trust Of Support.pdf HHSS 3/17/2016 3:00:00 PM
HB 234
HB234 Support_Alaska Mental Health Board-Advisory Board on Alcholism and Drug Abuse 3-15-16 (3).pdf HHSS 3/17/2016 3:00:00 PM
HB 234
HB 237 Opposition_Maureen Powers.pdf HHSS 3/17/2016 3:00:00 PM
HB 237
HB234 Support_american osteopathic association_ 3 15 16.pdf HHSS 3/17/2016 3:00:00 PM
HB 234
HB234 Support_Diane Ingle.pdf HHSS 3/17/2016 3:00:00 PM
HB 234